Saturday, May 16, 2009

From the Los Angeles Timeshttp://www.latimes.com/features/health/la-sci-nausea15-2009may15,0,3500051,print.story

Studies find two new methods for curbing nausea of chemotherapyGinger, a home remedy for helping an upset stomach, and a cocktail of anti-nausea drugs both reduced vomiting and sickness in cancer patients.By Shari Roan

May 15, 2009

Chemotherapy could soon become less grueling.

Simply adding about half a teaspoon of ginger to food in the days before, during and after chemotherapy can reduce the often-debilitating side effects of nausea and vomiting, a large, randomized clinical trial has found. And a newer type of anti-nausea drug, when added to standard medications, can help prevent such side effects as well.

The ginger results will be presented this month at the American Society of Clinical Oncology annual meeting; the drug study was published this week in the Lancet Oncology journal.

The findings are significant, cancer experts say, because about 70% of chemotherapy patients experience nausea and vomiting -- often severe -- during treatment.

"Chemotherapy has come to be the thing cancer patients fear the most," said Dr. Steven Grunberg, a professor of medicine at the University of Vermont and lead author of the study in the Lancet Oncology. "We've made a huge amount of progress, but we haven't completely solved the problem."

In the ginger study, 644 patients, most of them female, from 23 oncology practices nationwide received two standard anti-emetic medications at the time of chemotherapy. They also were given a capsule containing either 0.5 gram, 1 gram or 1.5 grams of ginger, or a placebo capsule. The patients took the capsules containing the placebo or ginger for three days before chemotherapy and three days after the treatment.

All of the patients receiving ginger experienced less nausea for four days after chemotherapy, said lead study author Julie L. Ryan of the University of Rochester Medical Center. Doses of 0.5 gram and 1 gram were most effective, reducing nausea by 40% compared with the patients on the placebo.

The study is the largest to examine the effect of ginger, already widely used as a home remedy for an upset stomach. One gram of ground ginger is equivalent to about 1/2 teaspoon. Ryan cautioned that some foods labeled as ginger, such as ginger ale or ginger cookies, may contain only ginger flavoring.

Researchers don't know why ginger seems to help, Ryan said. But, she added: "There is other research showing it has a potent anti-inflammatory effect in the gut."

In the study led by Grunberg, 810 patients were given two standard anti-nausea drugs, dexamethasone and ondansetron, that work by blocking a neural pathway in the brain that controls nausea. This two-drug regimen is most effective in preventing nausea and vomiting in the first 24 hours after chemotherapy.

One-third of the patients also received a one-day dose of the new drug, casopitant mesylate, while one-third received a three-day dose and one-third received a placebo.

Adding casopitant mesylate, the authors found, helped control symptoms in the so-called delayed phase of nausea that occurs beyond the first day after chemotherapy. Of patients receiving the standard two-drug regimen, 66% experienced no nausea or vomiting in the five days after chemotherapy, compared with 86% of patients taking a single dose of casopitant mesylate.

Casopitant mesylate probably adds extra relief from nausea because it acts on different nerve systems than the standard drugs, Grunberg said. Dexamethasone and ondansetron are in a class of drugs known as serotonin receptor antagonists; casopitant mesylate blocks the so-called NK1 pathway in the brain.

"NK1 antagonists work better for that later period," Grunberg said. "This study reinforces the value of this family of anti-nausea agents."

It also appears that the three-drug combination can be given on the day of chemotherapy without the need for additional doses, he said.

"That is a huge convenience for the patient, if we can give them all the drugs they will need for this period on the day they come to the clinic for chemotherapy," Grunberg said. "Our whole goal is maintain the highest quality of life during chemotherapy."